Chase, 3, is brought in by ambulance with his hand wrapped in a towel. His sweaty father – wearing running gear – explains that Chase touched the treadmill whilst Dad was in full flight.
A recently published paper in Burns reviews the epidemiology of treadmill burns;
Goltsman D, Li Z, Connolly S, Meyerowitz-Katz D4, Allan J, Maitz PK Pediatric Treadmill Burns: Assessing the effectiveness of prevention strategies.Burns. 2016 Aug 10. pii: S0305-4179(16)00064-4. doi: 10.1016/j.burns.2016.02.007. [Epub ahead of print]
Goltsman and colleagues reviewed a set of 298 treadmill burns sustained over a 10 year period in NSW, Australia.
Treadmills seem oddly specific, why the focus? Treadmill burns deserve our attention for three reasons;
Firstly, they are relatively common in the paediatric population, accounting for around 1 in 20
They’re most common in the 0-5 age group (mean age – 3.8yrs)
More often males; 62%
Treadmill burns are classically small, at less than 1% TBSA.
85% were burns to the hand, with a total of 91% being somewhere on the upper limb.
The lower limb, torso and head & neck each accounted for 4%, 5% and 7% of treadmill burns, respectively.
Secondly, the pathophysiology of treadmill burns is complex.
The basic mechanism is friction. Often, there is also entrapment of limbs, fingers or toes causing extensive and penetrating burns. Blunt trauma may occur when a child falls off the machine.
It is postulated that friction burns in children are particularly severe as their withdrawal reflex is relatively developmentally immature, and their volar epidermis is thinner. In concert, the slow reflex leads to prolonged burn time through more vulnerable skin.
In this data set, 62% of burns were full thickness.
Three quarters of the treadmill burns reviewed received no or inadequate first aid. First aid should be provided as per a typical thermal injury with 20 minutes of cool running water.
A significant number require reconstructive surgery; half the patients who sustained a treadmill burn received skin grafts.
An entrapment injury sustained whilst the treadmill was operating was more likely to require grafting.
How might we reduce the prevalence of treadmill burns?
The study data was obtained at a time when legislative changes led to mandatory safety warnings on treadmills. In addition to a multimodal public health campaign, there was a decrease in the annual number of treadmill burns throughout the study period. Yet, the most recent data (from 2014) still sees treadmill burns account for 4% of all paediatric burns.
Goltsman et al., moot the following suggestions to further reduce the risk of treadmill burns in children;
1. Safety devices could make it impossible for a child to start a treadmill;
2. Treadmills could have sensors in the area of danger for friction burns to automatically stop in case a body part gets trapped there;
3. The ‘‘stop’’ mechanism should be easy to reach even after a person has fallen from the treadmill, not just from a standing position; or
4. In order to prevent parents who are using the treadmill from failing to notice children standing or crawling right next to them behind the treadmill, the running treadmill could stop, or play an ‘‘alarm’’ noise if anyone comes close.
This study compliments and earlier review undertaken by Jermijenko et al in 2008;
Jeremijenko L, Mott J, Wallis B, Kimble R. Paediatric treadmill friction injuries. J Paediatr Child Health. 2009 May;45(5):310-2. doi: 10.1111/j.1440-1754.2008.01329.x. Epub 2008 Jun 12.